Scarlet Fever Poised for a Comeback

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Scarlet FeverScarlet fever, a potentially deadly childhood ailment that has been marginalized for at least a century, is beginning to return—but with some new tricks. An international study led by University of Queensland researchers has found that the development of antibiotic resistance is likely responsible for a recent scarlet fever outbreak in the United Kingdom and an earlier one in China.

Scarlet fever is caused by the group A type of Streptococcus bacteria. The disease can affect anyone but is most common in children between the ages of five and 12. During the 19th century, scarlet fever was the leading cause of death from disease in children across the U.S. and Europe. Even into the early 1900s, it still took the lives of one in 20 victims. For survivors, long-term and potentially crippling complications were possible. Among scarlet fever’s claims to infamy are its blinding and deafening of Helen Keller, killing two of Charles Darwin’s children, and its featured role in the 1922 children’s story The Velveteen Rabbit.

The rise of antibiotics has largely curtailed the lethality of scarlet fever in the past century, even in less-developed countries where it is more prevalent. In recent years, as a 2011 outbreak in China that sickened over 100,000 people showed, it has become more difficult to treat.

Genome sequencing undertaken by the University of Queensland team found markers for resistance to tetracycline, erythromycin, and clindamycin, three types of broad-spectrum antibiotics commonly employed to treat scarlet fever. Although only the Streptococcus strains from the Chinese outbreak were examined, researchers note that the disease’s antibiotic resistance could lead to more widespread changes in how scarlet fever can spread. Considering that England has seen its incidences of scarlet fever double in less than a year, it is a warning that may prove true.

On the bright side, as the researchers noted, penicillin still seems to work fine.

Scarlet fever commonly presents with a very sore throat, “strawberry” coloration on the tongue, a whitish coating on the tongue or back of the throat, and a fever of 101 degrees Fahrenheit or higher. Other frequent symptoms are nausea or vomiting, abdominal pain, and headaches. The characteristic red rash will first appear as small blotches that eventually become bumps with a sandpaper-like feel. The rash can appear alongside other symptoms or up to a week later. It originates on the neck, underarm, and/or groin before spreading across the body. Rare complications can include toxic shock syndrome, kidney infections, arthritis, and rheumatic fever.

Scarlet fever is usually transmitted by infected skin cells, clothing, shared utensils, or by aerosol. It is advisable for anyone with a sore throat to wash their hands regularly as a preventative measure.

Sources for Today’s Article:
Daniels, G., “Hong Kong Outbreak Marks Lethal Comeback of Scarlet Fever,” Empowered News web site, June 28, 2011;
Nouri, L., et al., “Transfer of Scarlet Fever-associated Elements into the Group A Streptococcus M1T1 Clone,” Scientific Reports 2015, doi:10.1038/srep15877.
“Scarlet Fever: A Group A Streptococcal Infection,” Centers for Disease Control and Prevention web site, January 20, 2015;
“Scarlet Fever Cases Soar in England,” BBC News web site, March 13, 2015;
“Scarlet Fever – Past and Present,” ScienceBlogs web site, July 6, 2011;